Is this ECG diagnostic of coronary occlusion? Also: Inferior de Winter ' s T-waves on prehospital ECG??

This post was written by one ofour fantastic Hennepin County Medical Center Emergency Medicine interns who is an ECG whiz, Daniel Lee.A man is his late 50 ’s presents to the ED with 1 hour of post exertional chest pressure associated with diaphoresis and nausea.  He has a history of known CAD, diabetes, and dyslipidemia.By pure clinical appearance, he looked like the textbook patient with acute MI.This is his first ECG in the department, which I saw as it was being printed:What do you think?Here is a previous baseline ECG from 3 years prior to compare:This was my interpretation of the first ECG:Sinus bradycardia with less than 1mm ST elevation in V4-V6, elevated compared to the previous ECG, suggestive of lateral MI.  Looking to the high lateral leads, instead of ST elevation that onemight see in a lateral MI there issubtle STdepression in aVL less than 1mm along with new T-wave inversion.  Leads II, III, aVF show about0.5 mm ST elevation that is new compared to the previous ECG.  Furthermore there is anew positive T wave in lead III.  Subtle changes, but with the history is very nearly diagnostic of acute inferior MI. Let ' s look at the 2 ED ECGs side by side:Limb leadsNow you can see the differences more clearlyAcute ECG on the left, with slight STE in left precordial leads, compared to the previous ECG on the Right.This patient had had two prehospital ECGs recorded, and these were viewed:30 minutes after reported onset of pai...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs